Purpose Although 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) with computed tomography (CT) and cardiac computed tomography angiography (CTA) are essential tools in diagnosing prosthetic heart valve (PHV) endocarditis, the normal imaging findings in the first year after PHV implantation on 18F-FDG-PET/CT and CTA have not been studied prospectively. We prospectively assessed the perivalvular FDG uptake at different time points after aortic PHV implantation and assessed the normal imaging findings on CTA. Materials and methods Patients who had undergone uncomplicated aortic PHV implantation were included and underwent 18F-FDG PET/CT and CTA at 5(±1) weeks (group 1), 12(±2) weeks (group 2) or 52(±8) weeks (group 3) after implantation. After a preparatory diet to suppress normal myocardial glucose uptake, FDG uptake in the myocardium as well as around the PHV was scored using the Qualification Visual Score for Hypermetabolism (QVSH) as "none" (< mediastinum), "low" (> mediastinum but < liver), "intermediate" (> liver), or "high" (intense uptake) and quantitative analysis was performed with maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio) on standardized European Association of Nuclear Medicine Research Ltd. (EARL) reconstructions by an experienced nuclear medicine physician. CTA was analysed for image quality, artefacts and stranding of the peri-aortic fat by a cardiac radiologist. Results In total 37 patients (group 1: n = 12, group 2: n = 12, group 3: n = 13) (age 66 ± 8 years) were included. Myocardial FDG uptake was intermediate or less in 29/37 scans (78%). QVSH around the PHV was 8/12(67%) low and 4/12(33%) intermediate in group 1, 7/12(58%) low and 5/12(42%) intermediate in group 2 and 8/13(62%) low and 5/13(38%) intermediate in group 3 (p = 0.91). No scan was scored as "none" or "high". EARL SUVmax was 3.48 ± 0.57, 3.50 ± 0.59 and 3.34 ± 0.55 (mean ± SD, p = 0.77) and EARL SUVratio was 2.00 ± 0.29, 1.96 ± 0.41 and 1.71 ± 0.26 (mean ± SD, p = 0.07) for groups 1, 2 and 3, respectively. One patient in group 3 refused to undergo the additional CTA and one CTA in group 3 could not be analysed for image quality and artefacts due to techniqual difficulties. Overall CTA image quality was "good" or "excellent" with an artefact score of "virtually none" or "mild" in most cases (n = 33, 94%). Stranding of peri-aortic fat was seen in 27/35 (77%) of these patients (group 1: n = 11; group 2: n = 9; group 3: n = 7) with no signs of FDG uptake on PET/CT scan. Conclusion Baseline FDG uptake around aortic PHV at 5, 12 and 52 weeks after implantation is similar and mild in the majority of cases with an overall mean SUVmax and SUVratio of 3.44 ± 0.56 and 1.89 ± 0.34 respectively. CTA revealed baseline post-surgical findings in the first year after PHV implantation.

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During the current corona pandemic, the question to which extent people could reach the middle of the elbow joint with the tip of their nose, which the Federal Ministry of Health recommended as a preventive measure when sneezing, was investigated with the help of an online questionnaire. The analysis included 316 fully completed online questionnaires and 16 additional telephone interviews, a total of 332 test persons (average age 29.5 (± 14.3) years, average BMI 22.9 (± 3.4) kg/m²; 226 women, 106 men). The results of this study show that 84.6% of respondents followed the recommended coughing etiquette and sneezed into the crook of their arm, 15.4% did not. The most common reason given for not using it was habit. Nevertheless, 92.8% of the participants found sneezing or coughing in the crook of their arm to be useful. When measuring the distance, 76.2% of the participants were able to touch the crook of the arm at the specific angle on both sides. The average measured distance was 1.13 cm on the right and 1.23 cm on the left. It was found that the BMI and age had a significant relationship with the measured distance. In a gender-specific comparison, more women than men sneezed into the crook of their arm, while no significant differences were found when measuring the distance. If the results of this study are put into practice, it makes perfect sense to continue to recommend sneezing or coughing in the crook of the arm. However, a note should be attached to this recommendation, which prompts one to take the sneeze position once and to check whether the crook of the arm can really be reached effectively. If this is not possible, alternative options should be recommended.

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